Electronic cigarettes and heated tobacco products belong to a new generation, differing in device design, yet there is no evidence to suggest they are less harmful than traditional cigarettes.
The World Health Organization (WHO) defines electronic cigarettes as products that have an electronic delivery system (e-cigarette), in the form of a device or separate components. These products are designed to produce aerosol for users to inhale.
Electronic cigarettes operate by heating a liquid that contains nicotine or is nicotine-free, along with flavoring agents. These substances are usually dissolved in propylene glycol and/or glycerin, and do not contain tobacco components.
At least 60 chemical compounds have been found in e-cigarette liquids (also known as e-liquids). Additionally, there are many other compounds in the aerosol or vapor produced by electronic cigarettes, with nearly 20,000 different flavors available.
Heated tobacco products create aerosols that contain nicotine and harmful chemicals when tobacco is heated, or when a device containing tobacco is activated. Users inhale these aerosols using a device. They contain highly addictive nicotine as well as non-tobacco additives, and are often flavored.
Thus, the main difference between electronic cigarettes and heated tobacco products lies in their design, where one type is equipped with an electronic system while the other is not, according to the WHO.
Heated tobacco contains traditional tobacco components, whereas electronic cigarettes do not. The essences and liquids in both products are added at the discretion of the user or the manufacturer. This leads to a lack of control over the types of liquids in new-generation tobacco products, including addictive substances and even drugs.
“There is no evidence that electronic cigarettes or heated tobacco products are less harmful than conventional cigarettes,” stated a WHO representative in Vietnam, adding that, in fact, both electronic cigarettes and heated tobacco contain nicotine which is highly addictive and detrimental to health, especially concerning brain development in children and adolescents.
The aerosol from electronic cigarettes contains harmful substances such as acetone, acrolein, acetaldehyde, formaldehyde, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), tobacco-specific nitrosamines (TSNAs), and metals. The concentrations of lead, chromium, nickel, and formaldehyde have been found in the aerosol of some electronic cigarette products at levels equal to or higher than those found in conventional cigarettes.
The aerosol from heated tobacco contains similar harmful chemicals to those in conventional cigarette smoke. The concentration of some chemicals in heated tobacco is lower than in conventional cigarettes. However, the concentration of other chemicals is higher, creating new substances not found in traditional cigarettes that could potentially harm health.
Electronic cigarettes disguised as milk boxes, targeting the youth. (Photo: Hanh Nguyen).
New-generation tobacco products do not help quit smoking
“Although manufacturers of electronic cigarettes and heated tobacco claim that these are alternatives for smokers and do not target youth, practical evidence shows that the products are aimed at a significant number of new customers who have never smoked, including women and children,” Mr. Luong Ngoc Khue, Director of the Department of Health Examination and Treatment, Ministry of Health, stated on May 15.
He also affirmed that there is no evidence that electronic cigarettes help people quit smoking traditional cigarettes. The WHO does not recognize electronic cigarettes as a cessation aid. On the contrary, evidence suggests that users of new-generation products are at an increased risk of using multiple types of tobacco simultaneously. Research indicates that individuals who have never smoked but use electronic cigarettes are 3.5 times more likely to start smoking traditional cigarettes.
Many countries have reported that users simultaneously consume both types. For instance, in the United States, the Centers for Disease Control and Prevention (CDC) reported that most electronic cigarette users trying to quit smoking do not succeed. Instead, they continue to use both products. Other studies show that about 70% of individuals in Japan and 96.2% in South Korea use both traditional cigarettes and heated tobacco products simultaneously.
Mr. Khue stated: “Encouraging smokers to switch to electronic cigarettes or heated tobacco does not help them quit but rather maintains their nicotine addiction and exposes them to multiple harmful chemicals by using various types simultaneously.”
In Vietnam, the Ministry of Health investigated tobacco use in 11 provinces and cities, showing that the rate of electronic cigarette use among students aged 13-17 increased from 2.6% in 2019 to 8.1% in 2023. In the 13-15 age group, this rate more than doubled, from 3.5% in 2022 to 8% in 2023. Among females aged 11-18, the rate of electronic cigarette use was 4.3% in 2023.
In 2023, Vietnam recorded over 1,200 hospitalizations due to the use of electronic cigarettes and heated tobacco, including many adolescents. Therefore, health experts urgently recommend banning the production and circulation of electronic cigarettes.
Currently, at least 39 countries and territories completely ban electronic cigarettes, while 18 economies prohibit heated tobacco. In the ASEAN region, five countries completely ban both electronic cigarettes and heated tobacco: Thailand, Singapore, Laos, Brunei, and Cambodia.
“The Ministry of Health’s stance on new-generation tobacco is a complete ban,” Mr. Khue noted. The Ministry is researching proposals for the government to present to the National Assembly to issue a resolution banning the production, trading, importation, and advertising of electronic cigarettes, heated tobacco, and other new tobacco products that may emerge in the future.
On May 13, Prime Minister Pham Minh Chinh requested various ministries and localities to implement multiple measures to enhance control and prevent the harm of electronic and heated tobacco.
